Keeping up with CPT 2003

• 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
  

• 76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up (e.g., reevaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, reevaluation of organ system[s] suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus
  

• 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal
  

Multiple births. There has also been a change in CPT instructions for coding multiple fetuses when performing a fetal biophysical profile (BPP). In the past, CPT instructed coders to use modifier -51 (multiple procedures) with each BPP code reported at that session after the first fetus (e.g., 76818, 76818-51 for twins). Now CPT indicates that a BPP done on additional fetuses should be reported separately by adding the modifier -59 (distinct procedure) to code 76818 (fetal biophysical profile; with non-stress testing) or 76819 (fetal biophysical profile without non-stress testing).

Transvaginal examination. CPT now explicitly states that if a transvaginal examination is done in addition to a transabdominal gynecologic ultrasound exam, coders should use code 76830 in addition to the appropriate transabdominal exam code (76856-76857).

Bone density studies

CPT now differentiates between a study done on the axial skeleton and one done on the peripheral skeleton, thanks to the revision of 1 code and the addition of a second:

• 76070 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
  
• 76071 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
  

Vaginal hysterectomy

The codes listed below were revised or added to account for the additional work involved in removing a large uterus vaginally. Report these new codes when the operative report includes a description of how the uterus was removed—by bisection, morcellation, or myomectomy and coring—and confirms the weight of the uterus. As with an abdominal hysterectomy, fibroid removal prior to uterus removal is considered an integral part of the procedure, and therefore is not reported separately. Note that if the weight of the uterus is not known at the time the procedure is coded, the default would be to code for the uterus that weighs 250 g or less.

• 58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less;
  
• 58552 with removal of tube(s) and/or ovary(s)
  
• 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58554 with removal of tube(s) and/or ovary(s)
  
• 58260 Vaginal hysterectomy for uterus 250 grams or less;
  
• 58262 with removal of tube(s) and ovary(s)
  
• 58263 with removal of tube(s), and/or ovary(s), with repair of enterocele
  
• 58267 with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58270 with repair of enterocele
  
• 58290 Vaginal hysterectomy, for uterus greater than 250 grams;
  
• 58291 with removal of tube(s) and/or ovary(s)
  
• 58292 with removal of tube(s) and/or ovary(s), with repair of enterocele
  
• 58293 with colpo-urethrocysto-pexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control
  
• 58294 with repair of enterocele
  

Myomectomy

CPT changed the uterine-fibroid removal codes to account for the more involved surgical work required for larger or multiple fibroids:

• 58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 grams or less and/or removal of surface myoma(s); abdominal approach
  
• 58145 vaginal approach
  
• 58146 Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams, abdominal approach
  

• 58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 grams or less and/or removal of surface myomas
  
• 58546 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams
  

Colposcopy procedures

CPT 2003 contains new and revised codes for colposcopy of the vulva, cervix, and vagina:

• 56820 Colposcopy of the vulva;
  
• 56821 with biopsy(s)
  
• 57420 Colposcopy of the entire vagina, with cervix if present;
  
• 57421 with biopsy(s)